Acupuncture and moxibustion in the treatment of ulcerative colitis: A randomized controlled study

Objective. Acupuncture has traditionally been used in the treatment of inflammatory bowel disease in China and is increasingly applied in Western countries. The objective of this study was to investigate the efficacy of acupuncture and moxibustion in the treatment of active ulcerative colitis (UC). Material and methods. In a prospective, randomized, controlled clinical trial 29 patients with mild to moderately active UC (mean age 37.8±12.0 years) were randomly assigned to receive either traditional acupuncture and moxa (TCM group, n=15), or sham acupuncture consisting of superficial needling at non-acupuncture points (control group, CG, n = 14). All patients were treated in 10 sessions over a period of 5 weeks and followed-up for 16 weeks. The main outcome measure was the change in the Colitis Activity Index (CAI) after treatment; secondary outcome measures were changes in quality of life, general well-being and serum markers of inflammation. Results. In the TCM group, the CAI decreased from 8.0 (±3.7) to 4.2 (±2.4) points and in the control group from 6.5 (±3.4) to 4.8 (±3.9) points (TCM versus CG: p=0.048). In both groups these changes were associated with significant improvements in general well-being (TCM group: from 3.0 (±1.8) to 1.8 (±1.0); CG: from 3.2 (±1.9) to 2.2 (±1.7)) and quality of life (TCM group: from 146 (±23) to 182 (±18); CG: from 157 (±20) to 183 (±23)). No significant differences between the TCM and CG were found regarding these secondary outcome measures. Conclusions. Differences in efficacy between traditional acupuncture and sham acupuncture were small and significant only for CAI as the main outcome measure. Both traditional and sham acupuncture seem to offer an additional therapeutic benefit in patients with mild to moderately active UC.

[1]  J. Mawdsley,et al.  RECENT ADVANCES IN BASIC SCIENCE PSYCHOLOGICAL STRESS IN IBD: NEW INSIGHTS INTO PATHOGENIC AND THERAPEUTIC IMPLICATIONS , 2005 .

[2]  Å. Danielsson,et al.  Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. , 2005, Gastroenterology.

[3]  P. Dieppe,et al.  Characteristic and incidental (placebo) effects in complex interventions such as acupuncture , 2005, BMJ : British Medical Journal.

[4]  N. Britten,et al.  Acupuncture as a complex intervention: a holistic model. , 2004, Journal of alternative and complementary medicine.

[5]  B. Göke,et al.  Infliximab for acute, not steroid-refractory ulcerative colitis: a randomized pilot study , 2004, European journal of gastroenterology & hepatology.

[6]  K. Linde,et al.  How informed is consent in sham-controlled trials of acupuncture? , 2004, Journal of alternative and complementary medicine.

[7]  B. Scott,et al.  How effective are the usual treatments for ulcerative colitis? , 2004, Alimentary pharmacology & therapeutics.

[8]  D. Schuppan,et al.  Acupuncture and Moxibustion in the Treatment of Active Crohn’s Disease: A Randomized Controlled Study , 2004, Digestion.

[9]  I. Vlachonikolis,et al.  The Inflammatory Bowel Disease Questionnaire: A Review of Its National Validation Studies , 2004, Inflammatory bowel diseases.

[10]  Yin Shi,et al.  Mechanisms of acupuncture and moxibustion in regulation of epithelial cell apoptosis in rat ulcerative colitis. , 2004, World journal of gastroenterology.

[11]  M. Verhoef,et al.  Complementary and alternative medicine use by Canadian patients with inflammatory bowel disease: results from a national survey , 2003, American Journal of Gastroenterology.

[12]  F. Klebl,et al.  Patients with refractory Crohn's disease or ulcerative colitis respond to dehydroepiandrosterone: a pilot study , 2003, Alimentary pharmacology & therapeutics.

[13]  A. Vickers Placebo Controls in Randomized Trials of Acupuncture , 2002, Evaluation & the health professions.

[14]  M. Kreitzer,et al.  Attitudes toward CAM among medical, nursing, and pharmacy faculty and students: a comparative analysis. , 2002, Alternative therapies in health and medicine.

[15]  Huan-gan Wu,et al.  Morphological study on colonic pathology in ulcerative colitis treated by moxibustion. , 2000, World journal of gastroenterology.

[16]  S. Joos,et al.  Immunomodulatory effects of acupuncture in the treatment of allergic asthma: a randomized controlled study. , 2000, Journal of alternative and complementary medicine.

[17]  E. Mayer,et al.  The neurobiology of stress and gastrointestinal disease , 2000, Gut.

[18]  H. Fliege,et al.  Validierung der deutschsprachigen Version des „Short Inflammatory Bowel Disease Questionnaire” (SIBDQ) , 2000 .

[19]  Huan-gan Wu,et al.  Study of the mechanisms of acupuncture and moxibustion treatment for ulcerative colitis rats in view of the gene expression of cytokines. , 1999, World journal of gastroenterology.

[20]  H. Yan,et al.  Observation of the efficacy of acupuncture and moxibustion in 62 cases of chronic colitis. , 1999, Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan.

[21]  C. Bernstein,et al.  An international survey of the use and attitudes regarding alternative medicine by patients with inflammatory bowel disease , 1999, American Journal of Gastroenterology.

[22]  R. Kessler,et al.  Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. , 1998, JAMA.

[23]  P. Anton,et al.  Neuroimmunomodulation in Inflammatory Bowel Disease: How Far from “Bench” to “Bedside”? a , 1998, Annals of the New York Academy of Sciences.

[24]  S. Targan,et al.  A Short-Term Study of Chimeric Monoclonal Antibody cA2 to Tumor Necrosis Factor α for Crohn's Disease , 1997 .

[25]  M. Cheang,et al.  Quantification of the placebo response in ulcerative colitis. , 1997, Gastroenterology.

[26]  H. Schouten,et al.  Adaptive biased urn randomization in small strata when blinding is impossible. , 1995, Biometrics.

[27]  Z. Chen Treatment of ulcerative colitis with acupuncture. , 1995, Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan.

[28]  G Lewith,et al.  Placebo controls for acupuncture studies. , 1995, Journal of the Royal Society of Medicine.

[29]  A. Herxheimer,et al.  Harnessing placebo effects in health care , 1994, The Lancet.

[30]  T. Lundeberg,et al.  Neuroimmunomodulatory effects of acupuncture in mice , 1991, Neuroscience Letters.

[31]  Ami,et al.  Coated mesalazine (5-aminosalicylic acid) versus sulphasalazine in the treatment of active ulcerative colitis: a randomised trial. , 1989, BMJ.

[32]  J. Whicher,et al.  Serum amyloid A protein compared with C‐reactive protein, alpha 1‐antichymotrypsin and alpha 1‐acid glycoprotein as a monitor of inflammatory bowel disease , 1987, European journal of clinical investigation.

[33]  B. Shine,et al.  C-reactive protein as an aid in the differentiation of functional and inflammatory bowel disorders. , 1985, Clinica chimica acta; international journal of clinical chemistry.

[34]  R. Summers,et al.  National Cooperative Crohn's Disease Study: results of drug treatment. , 1979, Gastroenterology.

[35]  Jacob Cohen Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[36]  Giovanni Maciocia,et al.  The Practice of Chinese Medicine , 2007 .

[37]  J. Kurtovic,et al.  Recent advances in biological therapy for inflammatory bowel disease. , 2004, Tropical gastroenterology : official journal of the Digestive Diseases Foundation.

[38]  J. Chen,et al.  Review article: therapeutic roles of acupuncture in functional gastrointestinal disorders. , 2004, Alimentary pharmacology & therapeutics.

[39]  J. Astin,et al.  Integration and reimbursement of complementary and alternative medicine by managed care and insurance providers: 2000 update and cohort analysis. , 2002, Alternative therapies in health and medicine.

[40]  B. Klapp,et al.  [Validation of the new German translation version of the "Short Inflammatory Bowel Disease Questionnaire" (SIBDQ)]. , 2000, Zeitschrift fur Gastroenterologie.

[41]  S. P. Zhang,et al.  Strategies to maintain the credibility of sham acupuncture used as a control treatment in clinical trials. , 1997, Journal of alternative and complementary medicine.

[42]  S. Targan,et al.  A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn's disease. Crohn's Disease cA2 Study Group. , 1997, The New England journal of medicine.

[43]  G. Greenberg,et al.  Oral budesonide as maintenance treatment for Crohn's disease: a placebo-controlled, dose-ranging study. Canadian Inflammatory Bowel Disease Study Group. , 1996, Gastroenterology.

[44]  B. Wu,et al.  [Effect of acupuncture on the regulation of cell-mediated immunity in the patients with malignant tumors]. , 1995, Zhen ci yan jiu = Acupuncture research.

[45]  C C LU,et al.  Chinese acupuncture and moxibustion. , 1962, Indian medical journal.